PURPOSE: To describe a case of a contact lens fitting in a patient with significant vertical imbalance without the use of prism. METHODS: A 56-year-old white female with vertical imbalance presented with the desire to wear contact lenses without the aid of spectacles. She was previously unsuccessful with rigid bifocal contact lenses, which incorporated vertical prism. RESULTS: The patient was successfully fit with monovision contact lenses without prism. CONCLUSIONS: It may be possible to fit a larger percentage of patients with vertical imbalance in contact lenses than previously thought.