Organic solar cells are on the dawn of the next era. The change of focus toward non-fullerene acceptors has introduced an enormous amount of organic n-type materials and has drastically increased the power conversion efficiencies of organic photovoltaics, now exceeding 18%, a value that was believed to be unreachable some years ago. In this Review, we summarize the recent progress in the design of ladder-type fused-ring non-fullerene acceptors in the years 2018–2020. We thereby concentrate on single layer heterojunction solar cells and omit tandem architectures as well as ternary solar cells. By analyzing more than 700 structures, we highlight the basic design principles and their influence on the optical and electrical structure of the acceptor molecules and review their photovoltaic performance obtained so far. This Review should give an extensive overview of the plenitude of acceptor motifs but will also help to understand which structures and strategies are beneficial for designing materials for highly efficient non-fullerene organic solar cells.