SIGNIFICANCE: Visual field loss is a common consequence of stroke and often precludes driving. However, legal visual requirements for drivers licenses are largely without scientific basis. PURPOSE: This study aimed to examine the effects of different types of homonymous visual field loss after stroke on simulated driving. METHODS: Data on performance and safety from a traffic simulator test for 153 participants with withdrawn drivers licenses due to visual field loss from stroke were retrospectively compared with data from 83 healthy individuals without visual deficits in a cross-sectional study. The 93 individuals in the stroke group who regained their driving licenses after a successful simulator test were then followed in a national accident database. RESULTS: Sixty-five percent of the stroke participants passed the simulator test (95% confidence interval, 57 to 72%). Younger patients were more successful than older. However, classification by neither type of homonymous visual field loss nor side of visual field loss was predictive of driver safety. Participants with hemianopia had their lateral lane position dislocated to the nonaffected side of the visual field. None of the participants with a regained license were involved in motor vehicle accidents 3 to 6 years after the test. CONCLUSIONS: In this large cohort, driver safety could not be predicted from the type of homonymous visual field loss. Even individuals with severe visual field loss might be safe drivers. Therefore, it seems reasonable to provide an opportunity for individualized assessments of practical fitness to drive in circumstances of licensing issues. This study demonstrates the potential of using a standardized driving simulator test for such assessments of fitness to drive.