Purpose: The purpose of this study was to investigate driving difficulties and Advanced Driver Assistance Systems (ADAS) use and preferences of drivers with and without central vision loss (CVL). Methods: Fifty-eight drivers with CVL (71 ± 13 years) and 68 without (72 ± 8 years) completed a telephone questionnaire. They rated their perceived driving difficulty and usefulness of technology support in 15 driving situations under good (daytime) and reduced visibility conditions, and reported their use experience and preferences for 12 available ADAS technologies. Results: Drivers with CVL reported more difficulty ( = 0.002) and greater usefulness of technology support ( = 0.003) than non-CVL drivers, especially in reduced visibility conditions. Increased driving difficulty was associated with higher perceived technology usefulness ( = 0.34, < 0.001). Dealing with blind spot road users, glare, unexpected pedestrians, and unfamiliar areas were perceived as the most difficult tasks that would benefit from technology support. Drivers with CVL used more advanced ADAS features than non-CVL drivers ( = 0.02), preferred to own the blind spot warning, pedestrian warning, and forward collision avoidance systems, and favored ADAS support that provided both information and active intervention. The perceived benefits of and willingness to own ADAS technologies were high for both groups. Conclusions: Drivers with CVL used more advanced ADAS and perceived greater usefulness of driver assistance technology in supporting difficult driving situations, with a strong preference for collision prevention support. Translational Relevance: This study highlights the specific technology needs and preferences of older drivers with CVL, which can inform future ADAS development, evaluation, and training tailored to this group.