Another use for the -O flag is that the value of the __debug__ builtin variable is set to False.
So, basically, your code can have a lot of “debugging” paths like:
if __debug__:
# output all your favourite debugging information
# and then more
which, when running under -O, won’t even be included as bytecode in the .pyo file; a poor man’s C-ish #ifdef.
Remember that docstrings are being dropped only when the flag is -OO.