We present the calculation of the Feynman path integral in real time for tunneling in quantum mechanics and field theory, including the first quantum corrections. For this purpose, we use the well-known fact that Euclidean saddle points in terms of real fields can be analytically continued to complex saddles of the action in Minkowski space. We also use Picard-Lefschetz theory in order to determine the middle-dimensional steepest-descent surface in the complex field space, constructed from Lefschetz thimbles, on which the path integral is to be performed. As an alternative to extracting the decay rate from the imaginary part of the ground-state energy of the false vacuum, we use the optical theorem in order to derive it from the real-time amplitude for forward scattering. While this amplitude may in principle be obtained by analytic continuation of its Euclidean counterpart, we work out in detail how it can be computed to one-loop order at the level of the path integral, i.e. evaluating the Gaußian integrals of fluctuations about the relevant complex saddle points. To that effect, we show how the eigenvalues and eigenfunctions on a thimble can be obtained by analytic continuation of the Euclidean eigensystem, and we determine the path-integral measure on thimbles. This way, using real-time methods, we recover the one-loop result by Callan and Coleman for the decay rate. As a byproduct of our derivation, we note that the optical theorem suggests an interpretation of the false-vacuum energy in flat space in terms of the normalization of the position or field eigenstate associated with the false vacuum, with unit norm corresponding to zero energy up to volume-suppressed effects. We finally demonstrate our real-time methods explicitly, including the construction of the eigensystem of the complex saddle, on the archetypical example of tunneling in a quasi-degenerate quartic potential. arXiv:1905.04236v1 [hep-th]