Economic evaluation is an increasingly important component of health and medical care policy making although it continues to be met with some resistance. Many fields of medical care services and public health have extensive economic evaluation literatures. In ophthalmology, the literature is less well developed and there is an ongoing discussion of the most appropriate methods. This article outlines different types of economic evaluations providing examples on their potential use in ophthalmic care decision making, reviews three articles in the brief recent literature on the cost-effectiveness of ophthalmic anesthesia and cataract surgery in the United States with a focus on explaining methods that were used, and discusses ways in which research in this area might be moved forward.