Structural Damage, Visual Field Loss, and Quality of Life in Optic Disc Drusen: A Case–Control Study with Integrated Data-Driven Phenotypes

<b>Background/Objectives:</b> Optic disc drusen (ODD) are an under-recognized cause of optic neuropathy, and the impact of structure-function damage on quality of life (QoL) is poorly defined. We compared systemic risk factors, ocular structure-function, and QoL in adults with ODD versus matched controls and identified determinants of impaired vision-related QoL. <b>Methods:</b> In a tertiary clinic, 60 adults with ultrasonography- or OCT-confirmed ODD were age- and sex-matched 1:1 to 60 controls without ODD. Retrospective clinical and imaging data (BCVA, RNFL thickness, standard automated perimetry) were combined with cross-sectional NEI VFQ-25 and EQ-5D-5L scores. <b>Results:</b> ODD patients more often had hypertension (51.7% vs. 31.7%, <i>p</i> = 0.026) and migraine (38.3% vs. 21.7%, <i>p</i> = 0.046). They showed worse BCVA (0.2 vs. 0.1 logMAR, <i>p</i> < 0.001), thinner RNFL (95.3 vs. 103.8 µm, <i>p</i> < 0.001), more depressed mean deviation (-4.7 vs. -1.3 dB, <i>p</i> < 0.001), and more frequent reproducible visual field defects (68.3% vs. 11.7%, <i>p</i> < 0.001). Vision-specific QoL was reduced (VFQ-25 composite 77.3 ± 11.4 vs. 89.7 ± 8.6, <i>p</i> < 0.001) and generic health status lower (EQ-5D utility 0.8 ± 0.1 vs. 0.9 ± 0.1, <i>p</i> < 0.001). In ODD, worse BCVA, more negative mean deviation and lower EQ-5D were independently associated with poorer VFQ-25 (model R² = 0.57), while older age, thinner RNFL and migraine predicted visual field defects. <b>Conclusions:</b> ODD are associated with substantial visual field loss and clinically meaningful decrements in vision-related and generic QoL.