Stochastic and inhomogeneous conformational changes regulate the function and dynamics of ion channels. Such complexity makes it difficult, if not impossible, to characterize ion channel dynamics using conventional electrical recording alone since that the measurement does not specifically interrogate the associated conformational changes but rather the consequences of the conformational changes. Recently, new technology developments on single-molecule spectroscopy, and especially, the combined approaches of using single ion channel patch-clamp electrical recording and single-molecule fluorescence imaging have provided us the capability of probing ion channel conformational changes simultaneously with the electrical single channel recording. The function-regulating and site-specific conformational changes of ion channels are now measurable under physiological conditions in real-time, one molecule at a time. In this chapter, we will focus our discussion on the new development of real-time imaging of the dynamics of individual ion channels using a novel combination of single-molecule fluorescence spectroscopy and single-channel current recordings. We will then discuss a specific example of single-molecule gramicidin ion channel dynamics studied by the new approach and the future prospects.